News & Opinion
“Care” vs “overzealous treatment”: Pope Francis speaks on end of life issues.(Acknowledgement to BioEdge)
Pope Francis has advised doctors to avoid “overzealous treatment” of patients at the end of life, saying that “burdensome” treatment may not be in the bests interests of the person.
The term ‘treatment’ however, needs careful consideration and understanding of how it is defined under UK law. Within the UK Mental Capacity Act (2005) the term ‘treatment’ is defined as:
‘any diagnostic or other procedure’ This is an extraordinarily wide definition in relation to true care of patients.
Addressing the World Medical Association European Regional Meeting on End of Life Questions — a conference jointly organised by the World Medical Association, the German Medical Association and the Pontifical Academy of Life — the Roman Pontiff said that the development of powerful medical technologies calls for prudent discretion on the part of clinicians.
“Within democratic societies, these sensitive issues must be addressed calmly, seriously and thoughtfully, in a way open to finding, to the extent possible, agreed solutions, also on the legal level. On the one hand, there is a need to take into account differing world views, ethical convictions and religious affiliations, in a climate of openness and dialogue.
On the other hand, the state cannot renounce its duty to protect all those involved, defending the fundamental equality whereby everyone is recognized under law as a human being living with others in society. Particular attention must be paid to the most vulnerable, who need help in defending their own interests. If this core of values essential to coexistence is weakened, the possibility of agreeing on that recognition of the other which is the condition for all dialogue and the very life of society will also be lost. Legislation on health care also needs this broad vision and a comprehensive view of what most effectively promotes the common good in each concrete situation”.
August 2017: What do we mean by ‘Dignity’. See Tiffany Dawson’s excellent ‘abundant life’ blog on this concept from CareNet website:
UK – October 2017. Former lecturer with Motor Neurone Disease, Noel Conway, fails in his bid to be helped to commit suicide but intends to appeal the ruling.
- His case was supported by Humanists UK and opposed by the secretary of state for justice, Care Not Killing and Not Dead Yet UK, also made submissions.The British Medical Association has previously expressed its opposition to physician-assisted dying, saying it risked putting “vulnerable people at risk of harm” and would be “contrary to the ethics of clinical practice”.
UK: Noel Conway Case for legal Assisted Suicide at the High Court on 17 July 2017
Attempts by Dignity in Dying to achieve a change in the law continue. This is despite the overwhelming defeat of the Maris Bill in 2015 by 330 – 118 votes and numerous preceding failed Bill attempts to change the law. This latest DID attempt, supports Mr Noel Conway, in yet another try for a change in the law.
Please see an analysis of this case from the Care not Killing Alliance here:
Nikki Kenward of ‘Distant Voices’ demonstrated outside the High Court (17 July 2017) during Noel Conway’s legal bid for assisted suicide. See Nikki talking to the BBC that day:
September 2017: US Congress ponders assisted suicide (Acknowledgements to BioEdge)
- A resolution condemning Assisted Suicide has been introduced to the US House of Representatives. See the link: https://www.bioedge.org/bioethics/us-congress-ponders-assisted-suicide/12453
Europe – Germany: Nurse may have killed at least 90 in German Nursing Homes
A male nurse, Neils Hogel, above, may have killed scores of patients in nursing homes in northern Germany. Nurse Högel was given a life sentence in 2015 after he confessed to the murders of about 30 people at two clinics. Even at the time police suspected that he was responsible for more deaths.
Evidence for these has emerged now after they exhumed and examined 134 bodies. It appears that Högel had given a number of them a lethal injection. Although the total will never be known, as a number of patients were cremated, it appears that he killed at least 90. This makes him the worst serial killer in Germany’s criminal history.
More information via this link (Acknowledgement to BioEdge) :
ROYAL COLLEGE OF NURSING : ‘Raising Concerns’:
Nursing staff should feel comfortable raising concerns, but speaking out is not always easy and often takes courage. Now a new RCN publication: ‘Raising Concerns’ supports you wherever you work and whether you act as an individual or as part of a group. Alongside a step- by- step guide, the publication looks at your rights and responsibilities; the support and response you should expect: and the differences between sharing concerns and whistle blowing. See the following link: http://www.rcn.org.uk/publications
Care Quality Commission (CQC ): Whistleblowing: Guidance: See the following link:
Public Concern at Work Charity– See the link to this UK Charity: http://www.pcaw.co.uk/
USA – September 2017: Are ‘brain dead. patients really dead?
A provocative new journal article challenges conventional accounts of human death.
A new article in the Journal of Medical Ethics challenges conventional accounts of human death, and calls for a “new consensus” on the ethics of vital organ transplantation. (Acknowledgements to BioEdge)
Bioethicists Michael Nair-Collins, of Florida State University College, and Frank Miller, of Weill Cornell Medical College, assert that patients who are brain dead may nevertheless be said to have retained the integrated functioning characteristic of human life. This is the case even when the patient is supposedly “dependent” on a ventilator.
The authors observe that that mechanical interventions (such as a ventilator) do not in and of themselves allow for the functioning of the lungs and heart — other natural bodily operations play and equally important causal role:
- “The ventilator does not cause the heart to beat. The ventilator does not cause gas exchange. The ventilator does not trigger the actions of the other organs. And the ventilator certainly does not cause the coordination of activity between the different organs. It blows air in and out; the living organism does all the rest.”
- The corollary to this is that the ethical justification for organ procurement from brain dead patients is undercut. “The science underlying the claim that the ‘brain dead’ are biologically dead organisms is weak and fundamentally flawed. Since the accepted ethical rationale for vital organ procurement from ‘brain dead’ patients relies on the validity of the neurological standard for determining death, the accepted ethical rationale is undermined as well.”The authors suggest that “a new consensus” must be reached on the ethics of vital organ transplantation — “one which is not premised on demonstrably false claims about the vital status of biologically living patients”.The provocative paper echoes claims made elsewhere about the invalidity of current justifications of brain death. It will be interesting to see how the bioethics community reacts to the growing clamour against conventional accounts of organismal death.
UK: 29 July 2017, Baby Charlie Gard dies
- The press statement of the Anscombe Bioethics Centre (Oxford), entitled “Doing the right thing for the right reasons” presents a well-balanced ethical analysis, see the following link:
Letter to the Telegraph, 17 July 2017, from Ann Farmer:
Dear Sir,Astonishingly, the state-appointed lawyer defending little Charlie Gard’s best interests is chairman of Compassion in Dying, a sister organisation of Dignity in Dying whose aims it shares, denies a conflict of interests in representing a child whose right to be treated is being decided (Anger at choice of Charlie’s lawyer,Telegraph, July 17, 2017).Dignity in Dying used to be the Voluntary Euthanasia Society, formerly the Voluntary Euthanasia Legalisation Society, which in the 1930s saw euthanasia as a weapon against overpopulation and called for it to be applied to patients with diseases like tuberculosis; if they had succeeded, no cures would have been found.Dignity in Dying say they want to legalise the killing of people with severe problems, but by now it is abundantly clear that legalisation, even with a very narrow remit and hedged about with safeguards, establishes the precedent that for the sick and disabled and indeed anyone who is “tired of life” (as in Holland), death is in their best interests. No treatment is guaranteed to work, and if we insist on cast iron proof that it will, we may as well give up on medicine and just kill people. It’s certainly cheaper.Yours faithfully,Ann Farmer
CANADA : Euthanasia provision ‘medical fees’
Canadian euthanasia doctors are pressuring the provincial governments to pay them more money for euthanasia. Supposedly, some euthanasia doctors have stopped killing people based on money.
An article by Kelly Grant published in the Globe and Mail, appears to pressure governments to pay more for euthanasia. The article insinuates that access to euthanasia has been impeded by the money doctors make to do lethal injections:Dr. Pewarchuk, an internal medicine specialist in Victoria who has presided over 20 assisted deaths, took his name off the list of willing physicians last month after the body that sets doctors’ pay in British Columbia approved new fees that he and some of his fellow providers say are so low they could chase away even the most committed physician supporters of assisted dying.Maclean’s magazine published an article by Catherine McIntyre stating that physicians in the Netherlands are paid more money to kill:In the Netherlands, for example, where physician-assisted dying has been legal since 2002, providers are paid a flat rate of about 1,500 euros. That’s $2,200 Canadian dollars and at least five times more than what MAID providers can earn in Canada. On top of that, Dutch physicians are given a paid day off after assisting a death to take care of themselves emotionally. (Correction: Professor Theo Boer sent a message to the Euthanasia Prevention Coalition’s Executive Director, Alex Schadenberg, stating that Maclean’s magazine was wrong. According to Professor Boer, doctors in the Netherlands receive 227 euro per euthanasia).
More from Canada: ‘The Slippery slope in action’
(acknowledgement to Lifenews)
See the video link: http://alexschadenberg.blogspot.co.uk/2017/07/mother-upset-after-doctor-offers.html
(Acknowledgement to Euthanasia Prevention Coalition)
In other news: Scotland:
A Scottish Catholic bishop wrote a passionate letter to his fellow Catholics in May 2017, urging them to speak out against the growing threats to human life. Bishop Stephen Robson of Dunkeld, Scotland wrote the letter for Scotland’s Day for Life on May 31, the Scottish Catholic Observer reports. He said:
Vulnerable people such as the disabled, elderly and frail are increasingly in danger from pressures to introduce assisted suicide or euthanasia. Campaigners have been relentless in pursuing their aim of introducing such laws. Worryingly, there is a broad coalition and considerable political support for extending the threats to life including extending abortion to birth for any reason.”
The Bishop’s letter also coincides with the release of new data showing that unborn babies with disabilities are being aborted at higher rates than in the past in Scotland.
UK: Multidisciplinary Conference: 08/05/2017. 10.30 – 16.15 hrs
(Convened by the Pro-life Nurses Group).Venue: the Royal College of Nursing, 20 Cavendish Square, London.
Keynote speakers: Dr Peter Saunders, Christian Medical Fellowship, Steve Fouch Head of Nursing, CMF and Paul Diamond, Standing Counsel for Christian Concern.
This was a well-evaluated programme with top class speakers. The delegates were interested in knowing more about this fundamental aspect of nursing in line with the expectation of the Nursing and Midwifery Council.
The dangers to the vulnerable today were explored well from Â the historical, pharmacological, legal, nursing and conscience perspectives.
The role of the nurse as patient advocate, is recognised as vital for patient well-being and safety, Â particularly in a utilitarian age with cost- cutting preoccupying many care settings. Shift patterns, particularly 12 hour shifts, were discussed, and are known from research to be a source of nurse stress and can impact greatly on care continuity but can, and should, be re examined for their contribution to both nurse and patient best interests.
- The Mental Capacity Act and the former Liverpool Care Pathway were revisited. Concerns were raised that the former inappropriate LCP practices are continuing in some areas. Discussion was generated about the need for automatic use of syringe drivers in Palliative Care. Though a useful means of giving drugs, this route is not always to be considered inevitable where inappropriate/not required. The defence of ‘merely obeying orders’ was emphasised from an historical perspective – as there is no defence in law, for ‘merely following orders’ when patients are harmed (Germany, Nuremberg World War II trials).
- The toll, both physical and psychological, on the nurse, in attempting to maintain the role of patient advocate can be significant. Nurses need full support in managing this inherent responsibility with help from the profession, the managers and each other. The importance of Clinical Supervision cannot be underestimated.
- The Nurse’s Code of Conduct is a good means of ethical and legal protection for both the patient and the nurse. There was good interaction with personal experiences being shared which included those from the nurses, a former patient, a bereaved relative (LCP experience) and a hospital visitor.
- Simple comfort measures and extra time given by nurses, particularly at the end of life, were discussed. These do not always require expense and can relieve the possible feelings of isolation or distress, particularly when patients are placed in single rooms.
UK February 2017. Hospital launches a probe after a stroke patient who suffered a fit in his care home is ‘put on a death pathway’
Walter Prescott, 62, was admitted to hospital in Bury after suffering a fit
His family claim he was put on a ‘end-of-life’ regime when he was discharged
Police are probing the death of Mr Prescott’s mother in similar circumstances
- Professor Patrick Pullicino, the neurologist who helped expose the LCP in 2012, said there were still big concerns over NHS palliative care. He called for new, fully evidence-based guidelines. Read more: http://www.dailymail.co.uk/news/article-4216162/Hospital-launches-probe-stroke-victim.html#ixzz4Yf9mw12X
New England Journal of Medicine, April 6, 2017: University of Pennsylvania bioethicists, Ronit Y. Stahl and Ezekiel J. Emanuel, have written a controversial article exploring Conscientious Objection laws which give health care professionals the legal right to refuse, on the basis of personal beliefs, to perform certain procedures or care for particular patients. The authors argue that professional societies should declare conscientious objection unethical and remove conscience clauses from their codes of ethics. This opinion has caused strong reaction among conservative bioethicists. According to the authors, objection to providing patient interventions…that the profession deems to be effective, ethical, and standard treatments…is unjustifiable. Stahl and Emanuel argue that doctors, in entering the medical profession, agree to abide by the ethical and professional standards of the profession: By entering a health care profession, the person assumes a professional obligation to place the well-being and rights of patients at the center of professional practice.
These authors suggest that doctors who object to standard practice should choose between the following two options: select an area of medicine, such as radiology, that will not put conscientious health care objectors in situations that conflict with their personal morality or, if there is no such area, leave the profession
We hope doctors and nurses will resist with all their might, together, as a strong body, this insidious, creeping culture which is as worrying as it is chilling. Belief in the right to exercise conscientious objection reflects the belief in universal human rights, the importance of recognizing conscience as fundamental to civilisation and ultimately the rights of vulnerable people.
Assisted Suicide: read an American nurse’s opinion via the link: https://nancyvalko.com/2017/01/04/the-slippery-slope-tactics-in-the-assisted-suicide-movement/
Oregon Bill Would Allow Starving Mentally Ill Patients to Death: http://www.lifenews.com/2017/02/06/oregon-bill-would-allow-starving-mentally-ill-patients-to-death/
Euthanasia Debate- fears of ill patient : http://alexschadenberg.blogspot.co.uk/2017/01/im-terminally-ill-and-euthanasia-debate.html
Catholic hospitals in Belgium which provide a substantial portion of psychiatric beds will permit euthanasia for non-terminally-ill patients. It is an unprecedented reversal of their stand on end-of-life care. Supporters of euthanasia, see this development as individual self-determination, which trumps long held Judeo- Christian prohibition. Such a development can only worry those who oppose euthanasia. Fifteen years after Belgium legalised euthanasia, most hospitals now provide this form of ‘care’. The overthrow of barriers which are an irresistible goal for the proponents of the culture of death has been achieved at the cost of Â true medicine and patient abuse. Many patients for euthanasia will be non- consenting as seen in those countries/states where euthanasia has been legalised.
The religious founders of these care facilities are opposed to this decision, taken by lay people now involved in the day to day running of the hospitals.
Switzerland: February 2017 : Completely ‘locked in’ patients can communicate: http://www.bbc.co.uk/news/health-38761461
A Dutch doctor who held down a patient and euthanised her against her will did not break the law, a panel has ruled. A committee in the Netherlands concluded that the doctor had “acted in good faith”, even though the patient, who had dementia, struggled when the doctor tried to insert the intravenous drip. The committee decided the case should be brought to court to determine whether other doctors who euthanise dementia patients will be prosecuted. Andrea Williams, Chief Executive of Christian Concern, described the case as “a tragedy”.
“This story is an example of the risks that the Netherlands liberal euthanasia laws are placing on the elderly, the sick and the vulnerable.
“It should never be for a doctor to decide on a patient’s behalf whether that patient wishes to live or die.
“Despite this tragedy, this doctor has not been charged. This sends the wrong message to Dutch society and indicates that others may carry out similar actions in future without facing prosecution.
“The Netherlands is increasingly embracing a culture of death, when instead it should be promoting life and doing more to protect it. It is vital that we firmly resist any such policies being implemented in the UK.
evangelicals say it‘s okay near the end of life?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
End of Life and Palliative Care, Nursing Times On line Comment:
Comment on: How EastEnders injected realism into Peggy Mitchell’s death
TERESA LYNCH’S COMMENT 19 MAY, 2016 4:29 PM
When will the BBC show at least a degree of balance to its programming? Peggy’s demise in
EastEnders is just the latest in the BBC’s apparent dedication to showing suicide as the best option
at the end of life. Its recent pro assisted suicide programme about Dignitas revealed a clear need
for another view to be portrayed. Many patients, whose time at the end of life is considered
precious by themselves and their families, and love life, can be so well managed without the need
for assisted suicide. The BBC’s negative portrayals of end of life experience need to be balanced by
a more positive experience of which there are many. The BBC in portraying repeatedly this
creeping, defeatist ‘control’ of all aspects of life as entitlement, should ponder the staggering
statistics on suicide for men under 45 in the UK. As a nurse opposed to euthanasia, it is well known
that once assisted suicide is legalised, it heralds in euthanasia as the experiences in Holland and
Belgium testify. Time will tell whether the BBC will decide on a more balanced approach to this
serious subject .
Comment on: ‘Nursing has for too long been outside assisted dying debate’
TERESA LYNCH’S COMMENT 26 JULY, 2014 7:37 AM
Medicine and nursing in the 21st Century ever seeks to increase the percentage of patients achieving a pain-free existence in the terminal phase of illness. Patients with end stage disease are a constant challenge to the vocational skills of their carers. In my experience, patients look to their carers to affirm their lives, not offer them death as a defeatist, cheap and easy option.
No one of any age or degree of illness is granted a pain-free existence. To suffer is part of the human condition. We see practical love operating frequently in times of natural disaster, to make bearable the suffering of those having experienced loss, natural disasters, torture, persecution, injustice,or bereavement, in other words, in all forms of suffering, whether mental or physical. What makes suffering bearable is the constant, invaluable support by family and friends, and of course their carers in their loving concern,support, and practical care for pain, wounds and misery.